I want to commend a book to you that came to my attention at a Palliative Care Grand Rounds session at Methodist Hospital a few weeks ago. The book is entitled, Mastering Communication with Seriously Ill Patients: Balancing Honesty With Empathy and Hope, by Anthony Back, Robert Arnold, and James Tulsky (New York: Cambridge University Press, 2009 ISBN 978-0-521-70618-6).
This book is written by physicians for physicians, and it addresses a pressing need in healthcare: The need for better communication between doctors and patients. The authors acknowledge that, for many physicians, communication is not their strong suit. They then proceed to lay out a practical, positive approach that doctors can use to relate more effectively with their patients. What impressed me, aside from the very fact that the book exists, is how similar the emphasis of Back, Arnold and Tulsky is to the emphasis of our training of volunteers and interns at Lifeline.
The authors articulate seven principles which illustrate their overall approach (pp. 6-7):
1. Start with the patient’s agenda.
2. Track both the emotion and the cognitive data you get from the patient.
3. Stay with the patient and move the conversation forward one step at a time.
4. Articulate empathy explicitly.
5. Talk about what you can do before you talk about what you can’t do.
Chapters are devoted to such thorny doctor-patient communication issues as: Talking about serious news; discussing prognosis; conducting a family conference; dealing with conflict; transitions to end-of-life care; talking about dying; and saying goodbye. In each chapter the authors lay out the problem, illustrate it, and lay out a “road map” for the physician to build communication skill in that area. Especially helpful are verbatim-like text boxes in which samples of a conversation are laid out under two columns: “What Happened” and “What We Can Learn.”
The authors function as empathetic, though uncompromising, coaches, providing their fellow physicians with practical tools, challenges, and encouragement in improving their relational skills.
Even though the book is written for physicians, I found it to be a very helpful review of basic communication skills and strategies. It merits close attention by anyone who works closely with persons dealing with serious illness and loss.
Author: Paul Riddle
